Steps to Prevent Violence in the Exam Room

September 1, 2016

Don't let a situation with an angry patient get out of hand. Here are steps to deescalate aggression in the exam room.

All doctors can tell stories of the patient(s) that they feared. In the most tragic cases, doctors have been killed by these angry patients or their loved ones. A doctor never goes into a patient encounter thinking how to defend themselves, but rather with the mindset of curing and helping. Most doctors are unprepared for when a patient suddenly goes ballistic and are put in harms' way.

Patients become angry for many reasons. Some are frustrated because no one can determine what is wrong with them or they may not believe your diagnosis. Others just want the controlled substance of their choosing in the quantity they want.

The first step to prevent this violence is recognizing the situations that may set a patient off. Regarding prescribing opioid medications, I rarely do it and let new patients know up front. This way they are given the chance to find another doctor before they are given a chance to rage at me. We should never give in to a patient we fear. They will just keep coming back and bring their friends with more and more requests.

Here are some other steps to deescalate aggression in the exam room:

- Always keep yourself between the patient and the door. Always have a way out that your patient cannot block your exit. Sure, your staff wants to help if something goes awry, but they are also doing other tasks and may not know what is happening right away.

- Never lose your temper, no matter what the patient is saying to you. Let them curse you out, insult you. When you respond in kind, it just escalates the situation. Sure, it is unpleasant and sometimes hurtful, but just remind yourself that once the patient leaves, you never have to see them again.

- Discharge patients from your practice who show aggression or behave inappropriately. We have enough to deal with in medicine these days so why add more misery onto it.-

- Talk in a calm. Controlled voice. Ask the patient to calm down. If you can't do this, leave the room.

- No means no. Don't let the patient pressure you into doing something you feel is medically improper. Explain your reasons.

- Tell the patient you will not argue with them. When I find myself in such a situation, I will explain my reasoning. I will answer patient's questions but when it becomes apparent that they are just trying to bully me into something, l tell them I am not changing my mind. If they continue, I tell them I am sorry I cannot help them further and leave the room. At this point, most angry patients give up.

- If a patient becomes overly hostile and you fear they will become violent, inform them that you are calling the police. And then call the police. Fake threats will be apparent.

- In this regard, have the number of the local police department posted in easy sight so anyone can call immediately.

- Have a signal with your staff letting them know they should go ahead and make the call. I have a certain head nod that I give my staff when it has reached the point that we need to bring in the police. Most often when the patient hears the call being made, they speed out of the office.

- If a patient crossed the legal line, press charges. I have a restraining order against a few hostile patients. You want to send the message that they are never to contact you again. You also don't want them to become some other doctor's problem. We need to work together to keep our jobs safe.

Most patients are appreciative of our time and efforts but it often seems that the angry ones make us overlook those patients. In no case should we ever allow patients to intimidate us. Sadly, it happens to all healthcare workers. If we see a nurse or anyone else being harassed, we need to step in and speak up. The healthcare workplace needs to be safe for all. If we stand passive in the face of abuse, we are part of the problem. Are you willing to take a st